Form 8038-Tc - Information Return For Tax Credit Bonds Page 4
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Form 8038-TC (Rev. 11-2012)
Page
Issuer's name:
Issuer's employer identification number (EIN):
Tax Credit Bond Code
Schedule for Qualified Zone Academy Bonds (QZABs)
Schedule C
Under Internal Revenue Code sections 54A and 54E
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104
See separate instructions
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Part I
Academy and Issuer Information
Yes
No
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Was the school located in an empowerment zone at the time the bonds were issued?.
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Was the school located in an enterprise community at the time the bonds were issued? .
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Is it expected that at least 35% of students attending the school or program will be eligible for free
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or reduced-cost lunches under the school lunch program established by the National School Lunch
Act?
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Was the comprehensive educational plan of the school or program approved by the eligible local
education agency? .
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Is a carryover of unused limitation being used for this issue? If “Yes,” enter the year in which the
limitation arose. (see instructions)
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Are the bonds issued by a state or local government within the jurisdiction of which the academy is
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located? .
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Does the issuer have written commitments from private business entities to make qualified private
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business contributions having a present value of not less than 10% of the proceeds of this issue?
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Was the bond issuance approved in writing by the eligible local education agency?
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Have these bonds been designated by the issuer as QZABs for purposes of section 54E? .
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Enter the name of the eligible local education agency:
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Description of the Private Business Contribution
Part II
(Enter the value of the amount of contribution in each type)
Amount
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Equipment
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Technical assistance .
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Services of donor's employees as volunteers .
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Opportunities for students outside of the academy .
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Other:
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Part III
Private Business Contributor Information (Attach a statement if more than five donors)
1 a Enter the name of the first donor:
b Enter the EIN of the first donor:
2 a Enter the name of the second donor:
b Enter the EIN of the second donor:
3 a Enter the name of the third donor:
b Enter the EIN of the third donor:
4 a Enter the name of the fourth donor:
b Enter the EIN of the fourth donor:
5 a Enter the name of the fifth donor:
b Enter the EIN of the fifth donor:
8038-TC
Form
(Rev. 11-2012)
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